PHYSICIAN BURNOUT: SYMPTOMS, CAUSES, ANTIDOTES

Burnout is the cascade of maladaptive responses that happens when demands from others and expectations from ourselves exceed our resources and coping skills.  The Maslach Burnout Inventory identifies a sequence of three core symptoms.  They are Emotional exhaustion (the loss of interest and enthusiasm for practice; Psychological withdrawal from work; Loss of concern or empathy for patients; Alienation from your own family), Depersonalization or disengagement (anger, cynicism, boredom, resentment, bitterness, blaming; treating patients as objects, reduced Pt satisfaction with care), and  Professional ineffectiveness, with reduced professional fulfillment (weakened professional identity; Career dissatisfaction; reduced sense of personal accomplishment; Doubting the value of your work role).  I summarize these as BAD MOOD, BAD ATTITUDE, & BAD WORK.  Burnout also often leads to acting out (e.g., obnoxious behavior at work, substance abuse) or premature departure from medicine.

Burnout is important because it is bad for everybody:  you, your family, your patients, and your residents and students, who are absorbing you as a model.  Nobody wants “bad mood, bad attitude, and bad work” to be your legacy to the future of medicine.    

So, let me offer a metaphor. A basketball, soccer ball, or volleyball is a very specialized and functional entity, with special qualities.  Despite constant handling, repeated pounding, and contact with many people, it retains its shape.  When impacted by its environment, it reacts effortlessly.  The result is what we know as “bounce.”  In humans, we might call this “resilience.”  Everyone needs the ability to bounce.  High functioning professionals like you have shown that you have it.  Think of burnout, then, as the loss of bounce.  After all, even the highest quality soccer ball, if abused long enough and badly enough, will lose its ability to bounce.  So, what is it that chews at the bounce in doctors?  How in the world can burnout happen in such high functioning professionals?

In the next blog, I will address the 4 contributors to burnout.